Alternatives for MRI in Prostate Cancer Diagnostics—Review of Current Ultrasound-Based Techniques

Abstract

The purpose of this review is to present the current role of ultrasound-based techniques in the diagnostic pathway of prostate cancer (PCa). With overdiagnosis and overtreatment of a clinically insignificant PCa over the past years, multiparametric magnetic resonance imaging (mpMRI) started to be recommended for every patient suspected of PCa before performing a biopsy. It enabled targeted sampling of the suspicious prostate regions, improving the accuracy of the traditional systematic biopsy. However, mpMRI is associated with high costs, relatively low availability, long and separate procedure, or exposure to the contrast agent. The novel ultrasound modalities, such as shear wave elastography (SWE), contrast-enhanced ultrasound (CEUS), or high frequency micro-ultrasound (MicroUS), may be capable of maintaining the performance of mpMRI without its limitations. Moreover, the real-time lesion visualization during biopsy would significantly simplify the diagnostic process. Another value of these new techniques is the ability to enhance the performance of mpMRI by creating the image fusion of multiple modalities. Such models might be further analyzed by artificial intelligence to mark the regions of interest for investigators and help to decide about the biopsy indications. The dynamic development and promising results of new ultrasound-based techniques should encourage researchers to thoroughly study their utilization in prostate imaging.

Comparative Assessment of Different Ultrasound Technologies in the Detection of Prostate Cancer: A Systematic Review and Meta-Analysis

“…Even in the early stages of PCa, angiogenesis causes increased flow, and CEUS can show imbalance of intraprostatic vessels and focal advancement [ 22 , 24 ]. Even though CEUS is a valid technique due to its own unique benefits, guidelines do not recommend it as a regular method for merging with MRI for the diagnosis of PCa, due to its defined and device-dependent interobserver accuracy shortcomings [ 25 , 26 ]. In addition, micro ultrasound (Micro-US) is another modality used to detect PCs.…”

Study on the Diagnostic Value of Contrast-Enhanced Ultrasound and Magnetic Resonance Imaging in Prostate Cancer

“…In western countries, prostate malignant tumor is considered as the common cancer, especially in elderly men [ 1 ]. It was reported that the occurrence rate of prostate malignant tumor raised every year, which severely affected the physical and psychological status of these patients [ 2 , 3 ]. Many studies reported that patients with prostatic cancer in the early phase who underwent timely treatment could gain a more than 5-year survival rate, while those in the end stage showed an obviously less than 5-year survival rate [ 4 ].…”

Detection of rare prostate cancer cells in human urine offers prospect of non-invasive diagnosis

“…Radiomics imaging approaches such as multi-parametric magnetic resonance of the prostate (mpMRI) and prostate-specific membrane antigen positron emission tomography (PSMA-PET) and new ultrasound scans are also in use for PCa screening and diagnosis 9 . As a result, crucial changes in the 2020 European Association of Urology (EAU) guidelines were established, promoting mpMRI to being recommended initially for every patient with suspicion of PCa (elevated PSA/abnormal DRE) before performing the biopsy 14 . Bourdoumis et al 15 reported a prostate-specific, non-protein coding RNA (PCA3) that is significantly overexpressed in PCa.…”